Prolonged inpatient E/M service each 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on per 15 minutes
- Prolonged inpatient E/M service each 15 minutes. Beyond primary inpatient service time.
Prolonged Services
Add-on code
Aetna: $0.00
Optum: $33.41
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Prolonged inpatient E/M service each 15 minutes. Beyond primary inpatient service time.
Telephonic evaluation 5-10 minutes
Individual psychotherapy, 60 minutes (53+ minutes).
Per telephone call
- Telephonic evaluation 5-10 minutes. For established patient, not originating from E/M service.
Telehealth
Primary code
Aetna: $0.00
Optum: $47.81
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Telephonic evaluation 5-10 minutes. For established patient, not originating from E/M service.
Telephonic evaluation 11-20 minutes
Individual psychotherapy, 60 minutes (53+ minutes).
Per telephone call
- Telephonic evaluation 11-20 minutes. Moderate complexity telephone evaluation.
Telehealth
Primary code
Aetna: $0.00
Optum: $77.20
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Telephonic evaluation 11-20 minutes. Moderate complexity telephone evaluation.
Telephonic evaluation 21-30 minutes
Individual psychotherapy, 60 minutes (53+ minutes).
Per telephone call
- Telephonic evaluation 21-30 minutes. High complexity telephone evaluation.
Telehealth
Primary code
Aetna: $0.00
Optum: $108.59
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Telephonic evaluation 21-30 minutes. High complexity telephone evaluation.
Care management for behavioral health conditions
Individual psychotherapy, 60 minutes (53+ minutes).
Once per calendar month
- Care management for behavioral health conditions. 20+ minutes per month. Requires care plan.
Care Management
Primary code
Aetna: $47.44
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Care management for behavioral health conditions. 20+ minutes per month. Requires care plan.
Care management for behavioral health conditions (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Once per calendar month
- Care management for behavioral health conditions. 20+ minutes per month. Requires care plan.
Care Management
Primary code
Aetna: $47.44
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Care management for behavioral health conditions. 20+ minutes per month. Requires care plan.
Psychiatric collaborative care management; first 70 min
Individual psychotherapy, 60 minutes (53+ minutes).
Once per patient (first month)
- Psychiatric collaborative care management; first 70 minutes. Initial month of CoCM program.
Care Management
Primary code
Aetna: $156.03
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychiatric collaborative care management; first 70 minutes. Initial month of CoCM program.
Psychiatric collaborative care management first 70 min (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Once per patient (first month)
- Psychiatric collaborative care management; first 70 minutes. Initial month of CoCM program.
Care Management
Primary code
Aetna: $156.03
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychiatric collaborative care management; first 70 minutes. Initial month of CoCM program.
Psychiatric collaborative care management; subsequent 60 min
Individual psychotherapy, 60 minutes (53+ minutes).
Monthly (subsequent)
- Psychiatric collaborative care management; subsequent 60 minutes. Following months after initial.
Care Management
Primary code
Aetna: $124.95
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychiatric collaborative care management; subsequent 60 minutes. Following months after initial.
Psychiatric collaborative care management subsequent 60 min (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Monthly (subsequent)
- Psychiatric collaborative care management; subsequent 60 minutes. Following months after initial.
Care Management
Primary code
Aetna: $124.95
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychiatric collaborative care management; subsequent 60 minutes. Following months after initial.
Psychiatric collaborative care management; each additional 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on per 30 minutes
- Psychiatric collaborative care management; each additional 30 minutes. Add-on to 99492 or 99493.
Care Management
Add-on code
Aetna: $64.57
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychiatric collaborative care management; each additional 30 minutes. Add-on to 99492 or 99493.
Psychiatric collaborative care management additional 30 min (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on per 30 minutes
- Psychiatric collaborative care management; each additional 30 minutes. Add-on to 99492 or 99493.
Care Management
Add-on code
Aetna: $64.57
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychiatric collaborative care management; each additional 30 minutes. Add-on to 99492 or 99493.
Medication assisted treatment services
Individual psychotherapy, 60 minutes (53+ minutes).
Per service episode
- Medication assisted treatment services. Comprehensive MAT services.
MAT Services
Primary code
Aetna: $205.25
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services. Comprehensive MAT services.
Medication assisted treatment services - extended
Individual psychotherapy, 60 minutes (53+ minutes).
Per service episode (extended)
- Medication assisted treatment services - extended. Extended duration MAT services.
MAT Services
Primary code
Aetna: $256.23
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - extended. Extended duration MAT services.
Medication assisted treatment services - intensive
Individual psychotherapy, 60 minutes (53+ minutes).
Per intensive episode
- Medication assisted treatment services - intensive. Intensive MAT services requiring significant resources.
MAT Services
Primary code
Aetna: $1,754.97
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - intensive. Intensive MAT services requiring significant resources.
Medication assisted treatment services - OTP comprehensive
Individual psychotherapy, 60 minutes (53+ minutes).
Per OTP episode
- Medication assisted treatment services - OTP comprehensive. Comprehensive OTP services.
MAT Services
Primary code
Aetna: $5,321.54
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - OTP comprehensive. Comprehensive OTP services.
Medication assisted treatment services - OTP follow-up
Individual psychotherapy, 60 minutes (53+ minutes).
Per OTP follow-up
- Medication assisted treatment services - OTP follow-up. Follow-up OTP services.
MAT Services
Primary code
Aetna: $421.76
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - OTP follow-up. Follow-up OTP services.
Medication assisted treatment services - OTP intensive
Individual psychotherapy, 60 minutes (53+ minutes).
Per OTP intensive
- Medication assisted treatment services - OTP intensive. Intensive OTP services.
MAT Services
Primary code
Aetna: $5,537.80
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - OTP intensive. Intensive OTP services.
Medication assisted treatment services - OTP monthly
Individual psychotherapy, 60 minutes (53+ minutes).
Monthly OTP
- Medication assisted treatment services - OTP monthly. Monthly OTP management.
MAT Services
Primary code
Aetna: $1,340.35
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - OTP monthly. Monthly OTP management.
Medication assisted treatment services - OTP assessment
Individual psychotherapy, 60 minutes (53+ minutes).
Per OTP assessment
- Medication assisted treatment services - OTP assessment. Initial OTP assessment.
MAT Services
Primary code
Aetna: $159.61
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Medication assisted treatment services - OTP assessment. Initial OTP assessment.